Republic of the Philippines )
Province of __________________) SS.
Mun/City of __________________)
x- - - - - - - - - - - - - - - - - - - - x
Province of __________________) SS.
Mun/City of __________________)
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WAIVER OF RIGHTS
OVER ELECTRIC POWER LINE
OVER ELECTRIC POWER LINE
I, ___________________________, of legal age, Filipino, single/married/widow, and a resident of ______________________________________, after being sworn in accordance with law, hereby declare that I do hereby WAIVE, TRANSFER and CONVEY all my rights, interest and obligations over the electric power line with Account No. _____________ with the _____________ Electric Cooperative in favor of _________________, who is also of legal age, Filipino, single/ married/widow), and a resident of ___________________, and who is able and willing to assume all my rights and obligations in connection with the said account with _____________ Electric Cooperative.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________, Philippines.
_________________________
Affiant
Witnesses:
_________________________ _________________________
Printed Name/Signature Printed Name/Signature
SUBSCRIBED AND SWORN TO before me, in the _____________________ this day of __________________ by ________________________ who has satisfactorily proven to me his/her identity through his/her _________________________ valid until ______________________, that he/she is the same person who personally signed before me the foregoing Waiver of Rights and acknowledged that he/she executed the same.
Book No. _____
Series of ______